Surgical and interventional radiology procedures involving the forearm, wrist or hand require varying degrees of support and immobilization of the extremity. A patient is placed in supine position on a mattress on top of a procedure table and their arm on which the procedure is to be performed is placed on an armboard, which is used to support and position the arm appropriately for the procedure and in some cases immobilize it to varying degree. Procedure tables used for surgical or interventional procedures may have such an armboard attached to them, or may have a separate armboard which is attached to the procedure table semi-permanently or at the time the procedure is performed on the patient.
Wrist supports, which may include makeshift assemblies of materials or devices specifically designed to support the wrist and hand, are also often deployed to position and limit motion of the wrist and hand. An example of a device designed for this purpose is found in pending application U.S. Ser. No. 13/199,821, “Apparatus and method of use for a wrist extension brace” by Benz et al, which has a filing date of Sep. 9, 2011. Additional examples are found in U.S. Pat. No. 4,798,199 by Hubbard and Brunson and in U.S. Pat. No. 5,845,643 by Vergano and Kovacs.
Procedure tables have mattresses that are placed on top of the table. These mattresses typically measure between one and three inches in thickness. The armboards are usually positioned so that their top surface is placed generally at the level of the procedure table, below the level of the top surface of the mattress; often the armboards are slid under the mattress with an arm platform portion protruding at the side of the mattress, with the patient's weight holding the armboard in place. An example of this kind of armboard is found in U.S. Pat. No. 8,369,933 by Crisco and Goff that describes a “substantially planar member” desirably including “both a radiolucent portion and a radiopaque portion”. Another armboard is found in pending application U.S. Ser. No. 11/962,767 by Kim, that describes an arm support that can be rotated “about an axis substantially coaxial with the patient's arm”, and having a locking mechanism and a bracket for attaching the arm support to a patient support, i.e. a surgical table. Since the top surface of these kinds of armboards is below the top level of the mattress, the patient's arm rests below the level of the shoulder when the patient is supine upon the procedure table, putting stress on the shoulder joint and creating discomfort for the patient. Towels or drapes or pads are often placed on top of the armboard under the arm to raise the level of the patient's arm to relieve discomfort and to properly position the procedure site for the clinician.
The hand is usually taped in a straight, supine-position onto the top surface of the armboard, immobilizing it, often with the wrist in extension. Though necessary for enabling proper clinician access for surgical and vascular access procedures in the hand, wrist and forearm, this arm positioning creates discomfort for the patient: while the forearm, wrist and hand naturally tend to pronate when the patient is in supine position with their arm at their side, during these procedures the entire arm is straight and rotated laterally stressing the wrist, elbow and shoulder joints.
Since many procedures on the forearm, wrist and hand are performed while the patient is conscious, the degree of patient comfort becomes increasingly important with procedures of long duration, i.e. certain surgical or interventional procedures. If discomfort is excessive this can cause difficulty for both the patient and clinician during the procedure. Because the patient's hand is taped to the armboard and covered by a sterile drape during the entire procedure, it is difficult to remove the tape to allow the hand to pronate. Further, allowing the hand to move freely is undesirable since the wrist and hand should be immobilized during and sometimes after the procedure, i.e. to prevent tree movement of the hand at the wrist since this can jeopardize devices inserted into a vascular puncture in the wrist, forearm or hand.
There is a need for an integrated system including armboard and wrist support devices to provide proper clinician access to the surgical or vascular access site on a forearm, wrist or hand, while improving patient comfort. At the time of this application there are no armboard or wrist support devices having the features described for the present invention.
Specific objectives of the invention include: i) providing a surface on which a patient's subject arm rests that is at least at the height of the top surface of the mattress on a procedure table; ii) removable and adjustable deployability onto a procedure table for a range of patient sizes normally encountered in a surgical or interventional setting; iii) enabling hand pronation at any time following commencement of the procedure.